He Said, She Said: Good for who?

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He Said

Our society’s problematic relationship with food has many elements, one of which is that we make sweeping generalizations and place foods, ingredients, and nutrients into dichotomous groups: good vs. bad, healthy vs. unhealthy, sinful vs. virtuous. When we use language like “good for you” to describe a given food’s supposed impact on our health, who is the “you” to which statements refer? That answer makes all the difference.

Those charged with shaping nutrition policy are faced with an impossible task. They do their best to create guidelines for the general population, but their advice fails much of the group because the truth is that when it comes to nutrition, individualization is a necessity.

In contrast, I have the privilege and good fortune to be able to focus on only one person at a time: whomever is joining me at my counseling table at any given moment. Recent conversations with some of my patients reminded me of just how essential it is to customize nutrition guidance.

For example, one evening I had back-to-back patients, one of whom utilizes whole grain products to her advantage in helping her stabilize her blood sugar, while the other must temporarily avoid such high-fiber food because of his acute gastrointestinal condition. If I had made a sweeping statement about whole wheat bread being “good for you,” I would have failed at least one of them.

Another day, I had a patient who is working to increase his potassium intake for the purpose of improving his hypertension and another patient who has renal disease and is on a potassium restriction. So, is a high-potassium food like cantaloupe “good for you” or what?

A couple of weeks ago, a patient referred to Gatorade as “crap,” to which I neutrally responded by mentioning that I drink it during long marathon training runs. He continued to say that my situation is different than his, which was exactly the conclusion I hoped he would reach when I decided to disclose that a beverage with no redeeming qualities in his eyes actually works quite well for me.

My one-decade anniversary of becoming a registered dietitian is coming up this summer, and during all my years of practicing, I cannot remember two patients who ever came in with the exact same set of circumstances. In reality, our situations are always different, as each of us has a unique set of health concerns, preferences, histories, cultural norms, financial considerations, and all of the other factors that together shape one’s relationship with food.

Instead of dividing foods into dichotomous groups that reflect sweeping generalizations about what is “good for you” in reference to the general population, take a morally neutral and pragmatic approach built on individualization. Recognize that every food has a set of attributes – including taste, cost, availability, nutrient content, and preparation options, just to name a few factors in its profile – that makes it more or less advantageous depending on the circumstances. Remember, the very food that you believe is “bad for you” might be great for someone else.


She Said

One of the underlying themes I have found amongst nearly all of my eating disorder (ED) patients is the idea that their ED often started with the intention to become “healthier.” Whether “healthier” meant to lose weight, improve certain biomarkers, or just feel better, these individuals embarked on a restrictive food mission, omitting certain “bad” foods (mostly foods high in sugar and fat) and replacing said foods with “good” foods (mostly vegetables and protein). As harmless as these initial intentions seem at first glance, for someone with ED, they often unravel into something potentially life threatening. 

For my patients with anorexia nervosa, this fixation on “good” and “bad” foods can result in a dangerously low body weight. In addition to extremely low weight, the lack of calories literally starves every organ of the body, including the heart and the brain. Brain scans of healthy control brains versus brains of patients with anorexia show that anorexia literally shrinks the brain. As such, these individuals undergo profound brain changes that lead to decrease in cognitive functioning (due to slowed neuronal growth), depressive symptoms (due to lower levels of neurotransmitters), and a reduction in affect displayed (due to shrinkage of the frontal lobe). What is really insidious about EDs is that they start off in the brain as mental illness and eventually lead to damaging the same brain by means of malnutrition. It is a vicious cycle.

The only way to break this cycle is by refeeding (in addition to therapeutic help and perhaps medication). In this initial stage of recovery, it is imperative that the patient take in enough calories to restore his or her body weight to their healthy weight range. In fact, it is almost impossible for therapeutic measures and medications to really help these patients until their brains are at least back to functioning levels. Many of my patients with severe anorexia struggle with brain fog, have trouble formulating thoughts, and cannot communicate clearly due to brain deficits, and this makes therapy not nearly as effective as when the brain is at least functioning at baseline.

The tricky part about refeeding is that many of the “bad” foods that these patients have been avoiding are, in fact, the same foods that will help them to restore weight most easily. These high carbohydrate/high fat foods are integral to getting these patients to their healthy weight ranges, as they usually have higher concentrations of calories than low carbohydrate/low fat foods. As such, these foods pack a much bigger punch, providing more calories in a smaller amount, making it easier for patients to get what they need while lessening the gastric overload.

Many of my underweight patients who need to weight restore will ask me if they can just eat more of the “good” foods to help them gain the weight back. Aside from heart-healthy nuts, avocados, and nut butters, most of the “good” foods fall into the low carbohydrate/low fat group that provides very few calories for the same volume. In other words, these noncalorically dense foods pack less of a punch, meaning that one would need to eat a much larger volume of these foods to get the same amount of calories that are in calorically dense foods. In order for someone to regain weight, eating large amounts of vegetables and protein is not going to get them to their goal as their stomach will simply prevent them from consuming enough.

What is “healthiest” for these patients is to consume calorie-dense foods and avoid those foods that take up more volume but do not provide the necessary calories. Thus, for the sake of example, a pint of Ben & Jerry’s ice cream is a better choice than a salad for someone who needs to regain weight. We have all been taught that certain foods are always “bad” in every context (ice cream, fried foods, sweets), but the example above shows that it is not so cut and dried. Is a pint of Ben & Jerry’s the “healthiest” choice for someone with high cholesterol? Possibly not. But for someone with anorexia who needs to gain weight, it is healthier. 

In other words, “healthy” is a very subjective term when it comes to nutrition. One size does not fit all as everyone has different health goals and medical conditions. While whole wheat bread might be the better choice for someone who suffers from chronic constipation, it would wreak havoc on someone with diverticulitis and should be avoided.   The “good food/bad food” dichotomy is problematic because it does not take the individual into account. The way we talk about food in our society needs to change.

Snack Ideas

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Lately it seems like almost all of my patients have been asking for snack ideas. In general, I have a few guidelines regarding snacks. First would be timing. Is the snack in question something that you just need to help you bridge a short gap between breakfast and lunch? Or is it something that will need to hold you over for several hours? Perhaps it is heading into “mini meal” territory, for those days when a sit down meal just isn’t going to cut it.

Of course, if it’s just a small snack to keep you from being ravenous for lunch or dinner, I would suggest picking a carbohydrate and then having it with a protein or a fat. What does that look like? An apple (carb) with a piece of cheddar cheese (pro/fat), pretzels (carb) with hummus (pro/fat), or a handful of trail mix made with nuts (pro/fat) and dried fruit (carb) are all great examples. Basically, the combination of carbohydrate and fat/protein is the best way to fuel your body between meals as it gives you some quick energy (carbs) and some energy that will satisfy you and keep your blood sugar levels steady (fats/proteins).

If a bigger snack is in order, I would recommend having at least a protein, a carbohydrate AND a fat. That could look like a peanut butter and banana sandwich; a homemade pizza bagel made with ½ a bagel, tomato sauce, some shredded mozzarella and perhaps a few slices of pepperoni; or a bowl of oatmeal with a tablespoon of peanut butter and a sliced banana. The main purpose of the bigger snack is to bridge a larger gap between meals while also making sure you will be hungry for the following meal.

Even if a patient knows that she is hungry for a snack, sometimes figuring out what exactly she is hungry for can be a challenge. In this instance, I would suggest going through a quick list of food qualities to help narrow it down. Am I hungry for something hot or cold or room temperature? Do I want something creamy and soft? Crunchy or hard? Am I in the mood for something savory or sweet or perhaps a mix of the two? Do I want something spicy? Salty? Bland? Sour? Am I hungry for something cheesy? Meaty? Chocolate-y? It may feel a little silly to go through a list like this, but sometimes it can just take a minute or two to figure out what will really hit the spot.

Some more snack ideas:

-cut up vegetables with ranch or bleu cheese dressing

-turkey slices with cheese and some crackers

-pretzels with peanut butter

-animal crackers with Nutella

-yogurt with granola and/or fruit

-1/2 of a turkey or roast beef sandwich

-tortilla chips with guacamole

-hardboiled egg and a piece of fruit

Something is better than “all or nothing”

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Lately it seems like I have a number of patients who are struggling. Whether it’s sticking to their prescribed meal plan, trying to incorporate more fruits or veggies into their diet or eating more intuitively, many of them are just finding themselves at a loss. When they are stressed out due to life’s challenges, they revert to their old ways of coping. For some that might mean restricting their intake and counting calories obsessively, for others that might mean zoning out on the couch watching TV with a bag of chips. Oftentimes I will hear the same reasoning: “I just couldn’t do [healthy habit] this week; it felt like too much effort.”

When we dig deeper, I often find that many of my patients have an “all or nothing” mindset about their eating. Either they are 100% committed to making healthy eating choices or they throw their hands up and say “screw it!” It might look something like this: a patient who has stated a goal that she only wants to eat out at restaurants twice per week found herself overworked and stressed and ended up eating out five times during that week. Or perhaps someone has set a goal of meal planning and grocery shopping every Sunday, but he just never gets around to it.

A lot of the time, these patients will come in to our appointment with their heads held low and feeling like failures. This isn’t the case! I look at these “failures” as data that we can use to help us in the future. Maybe the goals that were set were too much for that person at the time. Or perhaps there is another area of change that we should focus on. The best thing we can do in our session is to rework the goals that aren’t being met. Sometimes that means making these goals a bit more achievable (e.g. aiming for eating out 4 or fewer times per week for someone who is used to eating out 5 or more times per week).

The other idea I think is important is the “good enough,” concept. No one is perfect and similarly, when we expect ourselves to never fail, we are setting ourselves up for failure. Sometimes achieving parts of our goals is better than totally giving up completely. For instance, let’s say someone is really struggling with eating healthy lunches during the week. She is buried under paperwork and totally overextended at work and has been just grabbing a bag of chips from the vending machine. Ideally, she’d like to be packing her home-cooked lunches the night before and bringing them with her to work every day. But, it just isn’t happening. How about working on a middle ground solution? That could be bringing frozen meals for lunch instead of either buying potato chips or bringing home-cooked lunches. Are frozen meals ideal? No. But are they “good enough,” i.e. better than nothing? Absolutely!

The above example might feel uncomfortable for many people. Oftentimes, a patient will come into our session feeling like they have been “bad” because she didn’t achieve the goals we set last session 100%. What I say to that is: 1) maybe we didn’t set the right goal and 2) all you can do is the best you can do in that moment. Even if you don’t fully reach all of your goals, try to ease up on yourself a bit and realize that you are human. Something is always better than “all or nothing.”

“Weight that will stay off”

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TextThe above text exchange appeared in my Facebook feed, placed there by a personal trainer (whose name I blacked out from the image) who shared it to promote his business, a testimony to his prowess and the results he can bring to his clients who are seeking to lose weight.

Let’s talk about results. Losing weight is relatively easy and numerous paths to weight loss exist. Keeping off the lost weight, well, that is a completely different story. Research shows us that about 95% of people who try to lose weight will ultimately regain it (whether or not they maintain the behaviors that created the weight loss in the first place) and of that 95%, 60% of them will end up heavier than they were at baseline.

Said differently, if 100 people intentionally lose weight, five of them will keep it off, 38 of them will return to baseline, and 57 of them will end up heavier than when they started.

These facts may not be talked about very much in our weight-loss-obsessed society, but they are no secret. At the 2013 Cardiometabolic Health Congress, data were presented showing that this pattern of weight loss and subsequent regain was virtually identical regardless of the mode somebody used to lose it. That is why some people in the healthcare field say that the best way to gain weight is to go on a diet.

So when the trainer refers to his client’s 10 pounds of lost weight as “Weight that will stay off,” on what is he basing that claim? Based on the research, if he says something like that to 20 of his clients, 19 times he will be wrong. Not only is he misleading people with false promises and expectations, but he is putting them at high risk for weight cycling and the negative consequences with which it is associated.

Chances are better than not that the client in question will eventually regain the 10 pounds he or she lost plus more. What will the text exchange between the trainer and client look like then?

The sad thing is that I think the trainer in question is actually a good trainer in terms of the mechanics of his profession. He just needs to be more careful about the lessons he is teaching his clients. Had he responded to his client’s text with a sentiment along the lines of, “Losing weight feels important to you right now, but let’s remember that being physically active is doing wonders for your health and well-being regardless of what happens with your weight,” I would not be writing this blog.

Day 197: Control

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“It’s hard to keep things fresh and not become a parody of yourself. And if you’ve ever seen that movie Spinal Tap, you’ll know how easy it is. It’s a parody of what we all do. The first time I ever saw it, I didn’t laugh. I wept. I wept because I recognized so much in so many of those scenes. I don’t think I’m alone amongst all of us here in that.”

– The Edge, U2’s Rock and Roll Hall of Fame Induction, 2005


To be fair, Grey’s Anatomy is probably not the worst show on television, but the overly-dramatized plots and scenes that are supposed to make me laugh but do nothing of the sort leave me wondering what so many other people see in the show. Its long run of prime-time success seems to indicate that my opinion is that of the minority.

Above my other criticisms, the aspect of the show that rubs me the wrong way is how themes in patient care just so happen to mimic whatever events are going on in the doctors’ personal lives. Every episode this occurs. My eyes roll. As if someone is telling me the same joke over and over again, I want to interrupt and plead: Stop, please, I get it already.

Then to my horror, I realize the joke is on me: They’re right. The themes running through patient care and my own life really do seem to happen with such regularity.

In the midst of a late-summer walk, the inspiration hit me to try jogging for the first time since my surgery. I broke out into a jog and slowly shuffled along before the pain in my back was so intense that I had to slow down and resume my walking. Maybe I had jogged 20 yards, roughly the equivalent of crossing a wide street. This occurred in early August. According to surgeons’ predictions, I should have been able to start running in June.

In both life and healthcare, only some factors are in our control. The rest of them? Who knows. That is why I am so careful about tying goals to specific outcomes that are only somewhat under our influence. Furthermore, it is why I am wary of predicting how my patients will fare in terms of weight, cholesterol, blood pressure, or whatever other outcomes they are attempting to influence.

One of the most influential lessons in my life happened in the span of a few seconds in the south Pacific. As I sat on the boat’s edge preparing to snorkel at the Great Barrier Reef, a wave came up and dragged me into the water. There is power, and then there is power. Mine was dwarfed by that of the ocean, which had its way with me. While I struggled to get back to the boat as the water pushed and pulled me with much greater force than I anticipated, I had an epiphany of humility: We do not have as much control over our lives as we would like to think.

Having only limited control does not mean we should throw up our hands and give up. It just means we need to keep perspective, accept our limited power as we continue our work, temper expectations, and adjust to whatever comes.

After five months of waiting, I was finally cleared to begin physical therapy in late August. With the help of my therapist, I am working hard to reclaim my conditioning and put myself in the best possible position for my desired outcome: a return to competitive running and tennis. Neither sport is a possibility right now, even though I had expected to be able to resume both activities months ago. Given that, I have refocused my efforts on outdoor cycling.

Getting on my bike again was fantastic. Riding produces no pain whatsoever. Although my cardiovascular fitness has plummeted due inactivity and I am not able to ride as far now as I used to, just going through the routine of prepping my bike, putting on my helmet, starting my bike computer, and setting off down the road is the closest to the old me I have felt in just about a year. It makes me feel, well, normal.

We only have so much control over what happens and when, but if we keep our expectations in check and adapt accordingly, we can still find ways to thrive. I’m sure there must be a Grey’s Anatomy episode about that.


Obesity Cuts Life Expectancy, Santa Is Responsible for Your Christmas Presents, and Other Misleading Statements

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My interest in writing a blog right now is pretty much nil, but I cannot let today’s misleading boston.com article entitled “Obesity Cuts Life Expectancy by Up to 14 Years, Study Shows” go by without reacting, for I know the damage that pieces like this do to people, including some of my patients.

Long story short: The researchers who authored the primary source article did not adequately control for behaviors. They screened out potential participants who had ever smoked and/or had a history of certain diseases, but the lifestyle behavior information they collected from participants was limited to alcohol use and physical activity level. Researchers collected no information about other lifestyle factors, like stress management and eating and sleeping habits, all of which can impact health. The behavioral data they did collect was self reported, which introduces all sorts of error. Other research has shown that when behaviors are controlled for, body weight does not seem to matter, but the study design that these authors used prohibited any opportunity from being able to confirm or refute those findings.

The boston.com piece discusses a second article as well that examined the relationship between obesity and exercise. In reference to this latter article, the boston.com piece’s subheading concludes with, “And it’s under-exercise, not overeating, that’s causing America’s [obesity] epidemic.” That eye-catching text will certainly garner many clicks, which is unfortunate because it is not true. The actual research piece reads, “The research highlights the correlation between obesity and sedentary lifestyles, but because it is an observational study, it does not address the possible causal link between inactivity and weight gain.”

I cannot stress it enough: Correlation is not causation. They are entirely different. I know, I know, we each know somebody who has put on weight after they stopped working out. Sure, that does happen sometimes, but on the macroscopic level that is the population, the picture is much more complex than that with many other factors in play.

The boston.com article’s final paragraph begins with, “Losing weight is proven to significantly reverse the health effects of obesity.” Wrong. When we adapt healthier lifestyle behaviors, our body weight might change as well, but if we credit the weight change instead of the behavior change then we have it backwards.

The harm in all of this is that it reinforces a weight-centered model of eating and physical activity that ultimately fails nearly everybody who uses it. If we take a weight-centered approach and do not maintain the weight we want, we risk losing motivation and reverting to old behaviors because the goal was unattainable.

There is a better way. In the health-centered model that we advocate, the behaviors in and of themselves matter independent of weight. Whether weight goes up, down, or stays the same is irrelevant because the behaviors themselves are what count. Better-designed research seems to support this model: When we control for behaviors, health and weight look to be independent.

He Said, She Said: Meal Plans

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Creating meal plans based on calorie needs has been a staple of nutrition counseling for years. Is it time to say good-bye?

He Said

“The first session is about food. Every session after that is about why they [the patient] are not doing what I told them to do.”

That is how a seasoned colleague explained her work as a nutrition counselor to me when I was just starting out as a dietitian. With all due respect, the quote illustrates nutrition counseling gone awry, the result of an outdated, archaic, and ineffective approach that puts too much emphasis on information and too little on individuality and motivation.

A popular tool in dysfunctional nutrition counseling is the meal plan. While meal plans can take on different forms, the kind that I am referring to is based on an estimation of the patient’s calorie needs; those calories are then broken down into numbers of servings that said patient should consume from various food groups over the course of the day.

In theory, meal plans sound like a useful tool. From a dietitian’s standpoint, meal plans are easy to create, they give patients flexibility, and they put the responsibility for execution entirely on the patient’s shoulders. From a patient’s perspective, meal plans give a welcome sense of certainty and control, thereby temporarily relieving feelings of confusion and powerlessness. Just follow the meal plan and everything will be okay, right?

Unfortunately, the problems with these meal plans are extensive:

  • Estimates of the patient’s nutritional needs are not tremendously accurate. The most accurate means of measuring one’s resting metabolic rate is through direct calorimetry, which involves spending time in a chamber that measures the heat he or she generates. To my knowledge, direct calorimetry never happens outside of a research setting.  Even direct calorimetry has its problems, and every other method available has larger sources of error. Practitioners like us use algorithms that estimate calorie needs based on height, weight, age, gender, and similar data. Attempts to quantify calories expended through physical activity introduce additional error. Calculations of one’s calorie needs are at best just rough ballpark estimates. Therefore, the whole foundation of the meal plan is shaky.
  • The reported calorie content of different foods can also be inaccurate. Whether due to faulty assumptions used in the calculations or labeling laws that allow for rounding off, what we believe to be the nutritional content of a given food is sometimes not quite true. Yet the numbers are taken too literally, and patients exhaust themselves with kitchen scales and measuring cups trying in vain to consume the exact number of prescribed calories, a goal that is virtually impossible to achieve.
  • The expectations put on meal plans are unrealistic. With genetics, environment, stress, and other variables heavily influencing health and weight outcomes, the notion that a meal plan can guarantee virtually any measure of success is nonsense and misleads patients.
  • Meal plans fuel the inaccurate “good food, bad food” dichotomy. Foods present on the plan are seen as “good,” while those that are absent are considered “bad.” One meal plan form that I used to use omitted some fruits for no other reason than space did not allow for a complete list, yet countless patients expressed criticism and fear of the fruits that did not appear on the plan.
  • Meal plans focus heavily on individual foods, but much of the foods we consume in real life are combined with other foods in unknown quantities. Even when we prepare foods at home, estimating, for example, the volume of beans in minestrone soup, or cheese on pizza, or oil used in a stir-fry with any degree of accuracy is a time-consuming and tedious challenge. When eating in a restaurant or buying prepared foods, forget it; there is virtually, or in many cases literally, no way to know. The meal plan paradigm of tracking portion sizes fails when portion sizes are uncertain.
  • Meal plans teach patients to follow external cues for their eating. This may work in the short term, but not in the long run. At best, relying on a meal plan delays the development of mindful-eating skills. If long-term change is to occur, it is virtually inevitable that one must learn to eat in response to internal cues.

Following in the footsteps of my more experienced colleagues, I put hundreds of patients on meal plans at the beginning of my career. Some of these patients saw short-term improvements in their health or weight, but I cannot recall even a single instance of a meal plan approach spawning long-term behavior change. When things inevitably fell apart, patients blamed themselves, but really the problem was the approach. For that reason, I recognized meal planning as the dated and ineffective technique that it is and almost entirely removed it from my counseling tool box.

The only exception is that I still use meal plans for some patients with eating disorders. Sometimes the stakes are so high that inadequate nutrition risks hospitalization or admission to an inpatient program, so in these cases I temporarily use meal plans in an effort to keep the patient safe. In the long run though, as the eating disorder is overcome, we leave the meal plan behind and work on mindful eating.

There are times I do devise lists of meal and snack ideas with my patients, but do not confuse these with the meal plans that I have discussed up to this point. Working together with my patients to devise individualized ideas for what they can eat in certain situations can be very helpful due to the customization and collaboration. The utility is quite different than just writing in some numbers on a meal plan sheet, handing it over to them, and then getting together next session to discuss why they are not following it.


She Said

To meal plan or not to meal plan, that is the question. A lot of people assume that since the majority of my patients are those with eating disorders, that I must use meal plans with all of my patients. This most definitely is not the case. When a patient first comes to see me, I spend the initial session (or two) learning about that patient: Why are they coming to see me? How have they been eating? At what point in their recovery are they? These are all questions that can help me decide whether a meal plan is indicated or not.

Meal plans, in my opinion, are training wheels for those struggling with feeding themselves adequately. Usually, if a patient has just left an inpatient or residential eating disorder treatment facility and is having a hard time eating all of her meals and snacks at home, I find that a meal plan can be very helpful to get her back on track. But, just like training wheels, the meal plan should not be permanent, and eventually the patient should be weaned off of it.

The ultimate goal that I want to help my patients achieve is the ability to engage in intuitive eating. In a nutshell, intuitive eating is eating when you are hungry, stopping eating when you are satiated, and eating what feels best to your body. This also means not eating according to external rules, but rather listening to your body and honoring its cues.

As I’ve mentioned before in other blogs, we are born with the innate ability to regulate our food intake. When a baby is hungry, she will cry until she is fed. When she is full, she will turn away from the offer of more food. Even toddlers still use internal cues to determine when and how much they want to eat. But, eventually, we begin to lose the ability to listen to our body’s cues when we start placing external regulations on our eating (e.g., eating according to a strict schedule, dieting, being a member of the clean plate club, etc.). This behavior causes us to lose touch with our body’s innate wisdom and can lead to disordered eating.

I rarely, if ever, use meal plans with my non-ED patients, although I’ve had many of them ask for one. I find that those patients who ask for meal plans are the ones that want to be told what, when and how much to eat and don’t trust themselves to feed themselves appropriately. They want to rely on external regulations around their eating, as they feel that if left to their own devices, they would devour an entire sheet cake in one sitting. In these instances, using a meal plan is not a good idea, as it just reaffirms in that patient’s mind that she is incapable of feeding herself solely by using her internal wisdom.

In sum, while I think meal plans can be a useful tool in ED recovery, they are not indicated in every instance. The ultimate goal is to relearn how to eat intuitively, and that means not relying on a meal plan, but instead listening to one’s gut.

What Is the Difference Between a Nutritionist and a Dietitian?

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NutritionistThe title of Nutritionist is unregulated. Anybody can call themselves a Nutritionist. You are a Nutritionist. Your neighbor is a Nutritionist. So is your infant. And your dog. The title is meaningless and does not indicate that the person has any training or expertise whatsoever in nutrition.

In contrast, the title of Dietitian (short for Registered Dietitian, RD) coveys that we completed a program of formal academic study in nutrition, graduated from an accredited internship program that included working in a wide range of specialties within the field (everything from food service to organ transplant), passed our boards, partake regularly in continuing education, are registered with the Commission on Dietetic Registration, and have a license to practice in the state. Dietitians are held to a code of ethics, just as doctors, nurses, and other licensed health care practitioners are, and we are recognized within the medical community as the experts in nutrition.

Despite the meme posted at the top, some Dietitians do refer to themselves as Nutritionists. Doing so is nothing more than a public relations strategy. While Nutritionist is a hollow title that means nothing, its inclusion of the word “nutrition” yields a title to which laymen can relate. Furthermore, some people mistakenly believe that Dietitians only work inpatient jobs at hospitals. These misunderstandings are so common that the Commission on Dietetic Registration now gives the option for a Dietitian to call him or herself by the alternate title, Registered Dietitian Nutritionist (RDN).

So, all Dietitians are Nutritionists, but not all Nutritionists are Dietitians. If you are looking for help with your eating, check the person’s credentials first and make sure he or she is a Dietitian.

Is the Risk of Foodborne Illness Worth It?

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Almost immediately after posting a Wall Street Journal article entitled “Does Rinsing Fruit Make a Difference?” on our Facebook page yesterday, I got an email from a family member talking about pre-washed salad mixes in the past tense (“What a convenience they were.”) and asking me if I will change my own eating habits because of this article.

When it comes to foodborne illness, risk always exists.  One can take every known precaution and still contract a foodborne illness, or one can grotesquely forgo all food safety guidelines yet not get sick.  The question is not one of risk’s presence, but rather one of risk’s relative magnitude.

Each one of us has to decide for ourselves how much risk we are comfortable taking.  The article talks about the health of one’s immune system as being an element of consideration, but other factors are in play, too: What does one like to eat?  What can one afford?  How much time does one have for food preparation?  What are the realistic alternatives if one forgoes a given food?  Pros and cons exist for eating and not eating a given food, and these must all be considered before reaching a conclusion. 

The answer to my family member’s question is no, I will not be changing my own eating based on this article.  Generally speaking, I do not care for vegetables.  I know, I know, a dietitian who does not like vegetables.  As it turns out, dietitians are people too and we have our own challenges with food just like everybody else.  The modes in which I enjoy vegetables are slim: carrots and peppers dipped in humus, spinach in lasagna, and broccoli and mushrooms on pizza.  In terms of true enjoyment, that’s about it.

Raw salad greens topped with fresh fruit and nuts are moderately enjoyable, but the tipping point is such that convenience is a major factor for me.  Take away pre-washed salad mixes and the likelihood that I will buy whole greens and prepare a similar mixture on my own is very slim.  Therefore, when I weigh their benefits against the risk of foodborne illness, continuing to consume pre-washed salad mixes makes sense for me.

Somebody else might reach a different conclusion for his or her own life and that is perfectly fine.  My case is nothing more than an example; I am not suggesting that others should or should not reach the same conclusion for themselves that I have reached for myself.  Everybody has different needs, priorities, goals, and constraints, which is why Joanne and I feel so strongly about providing individualized nutrition counseling that is customized for each one of our patients.

Individualized Nutrition Counseling

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I spent the last four days at the Cardiometabolic Health Congress, where international experts in cardiovascular and metabolic health gathered to discuss the latest developments in our field.  One of the talks that I think will be of most interest to you, our readers, addressed the question: Which diet is the best for losing weight?

The presenter discussed a study that compared the weight loss of subjects put on over 20 different popular diets.  As it turned out, there was no significant difference in weight loss between any of the diets.  The pattern was the same for each: sharp initial weight loss, followed by steady weight regain.

In other words, the study supports what other research has shown too, namely that dieting does not work in the long run.  Furthermore, it does not matter which diet one chooses, as each diet is just as good at ultimately failing as any of the others.

The presenter shared another study that looked not at weight, but at actual markers of health (i.e. cholesterol, blood pressure, blood sugar, etc.) and found that the dietary approach that a person takes absolutely matters in regards to these markers.

So, what is that dietary approach that makes such a difference for health?  An individualized approach.  There is no one eating pattern that will work for everybody; it has to be tailored to the person in question.  The presenter stressed the importance of taking into account the specific person’s preferences, risk factors, current habits, and goals.

In other words, to really make a difference in terms of somebody’s health, he or she does not need another diet, but rather individualized nutrition counseling.  We at Soolman Nutrition and Wellness LLC already knew that, which is why you see the term “Individualized Nutrition Counseling” on our website, business cards, brochures, and advertisements.  I will say though that it was nice to receive confirmation that the approach we take with our patients is supported by the most current research.

If somebody you know is sick of diets failing and he or she is ready to get healthy, send him or her our way and we will be happy to help.